An update on the Health and Care Bill

Posted on 19/07/2021 by Ed Hammond.

Happening parallel with England’s run of success at the Euros (and ongoing covid rolling news), the introduction into the Commons of the long-awaited Health and Care Bill received less media coverage than it perhaps ought to have done.

Here is the second fundamental reorganisation of the NHS in less than a decade – at once a seismic change to the health and care landscape and an evolution of a direction of travel which has been apparent since the birth of Sustainability and Transformation Plans (STPs) in 2016 and one which is seen as being much more health driven and wanted than previously.

We’ve had confirmed much of what we expected from the White Paper (you can read our position paper on the subject for more information on the original proposals).

The WP looked as though it would give additional powers to the Secretary of State – a turbocharged version of the intervention powers he already has. Well, the Bill certainly lives up to that promise, and then some. In truth, this continues to be a real concern. As an organisation we are committed to local accountability – and to local health scrutiny, which has delivered big wins for local people since it started in 2003. Health scrutiny itself isn’t going – but the removal of the statutory referral power, which gave health scrutiny committees a central role in big health reconfigurations, will be a big blow.

What happens now? We’re talking to other national bodies about the steps they plan to take over the summer to propose amendments to the Bill when it enters committee stage (presumably once Parliament returns following its summer recess). Over this period we’ll also be in touch with the DHSC Bill team, to learn more about their expectations of the content of future Regulations and guidance, which will give us a fuller picture of the likely dynamics and powers for health scrutiny once the Bill becomes law.

If the Secretary of State is to draw in more powers to intervene in local health services on a rolling basis, he will need evidence to support that power. We think that the statutory referral power should form part of that evidence – and could provide a form of local accountability for this national decision-making, enabling the Secretary of State to demonstrate that, in acting, he is having regard to evidence gathered by elected local politicians. We have produced a draft of a possible way that this could be expressed in legislation (whether that be through an amendment to the Bill itself or new Regulations on health scrutiny).

An NHS anchored by the needs of local people is an accountable NHS – health scrutiny provides a strong part of this accountability. We are going to continue to fight hard to ensure that health scrutiny is eventually bolstered, rather than diminished, by this legislation.

About the Author: Ed Hammond

Ed leads CfGS's work on devolution, transformation and on support to councils and other public bodies on governance and accountability.